Provider Demographics
NPI:1508614504
Name:ROTHENHOEFER, MADOSIN ORION
Entity Type:Individual
Prefix:MS
First Name:MADOSIN
Middle Name:ORION
Last Name:ROTHENHOEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 FOUNTAINS PKWY # FAIRVIEW
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2170
Mailing Address - Country:US
Mailing Address - Phone:618-515-1441
Mailing Address - Fax:618-515-1441
Practice Address - Street 1:343 FOUNTAINS PKWY # FAIRVIEW
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2170
Practice Address - Country:US
Practice Address - Phone:618-515-1441
Practice Address - Fax:618-515-1441
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician